Brassington, Iain. "Dedication." Bioscience and the Good Life . London: Bloomsbury Academic, 2013. v#vi. Bloomsbury Collections . Web. 31 Jul. 2020. <>. Downloaded from Bloomsbury Collections, www.bloomsburycollections.com , 31 July 2020, 00:18 UTC. Copyright © Iain Brassington 2013. You may share this work for non-commercial purposes only, provided you give attribution to the copyright holder and the publisher. Man, they said, is a very noble organism. We have dealt with other organisms so as to enhance in each its noblest attributes. It is time to do the same with man. – Olaf Stapledon: Last and First Men x Acknowledgements Parts of this book reproduce or adapt work that has been published or presented elsewhere. Chapter 5 reproduces material published as ‘ Body Art and Medical Need’ in the Journal of Medical Ethics (32(1): 13– 16, 2006); Chapters 8 and 9 recycle and adapt material published in Bioethics as ‘ John Harris’ Argument for a Duty to Research ’ (21(3): 160– 8, 2007) and ‘ Defending the Duty to Research?’ (25(1): 21– 6, 2011). The argument of Chapter 4 was presented as a paper at the ‘ Transforming the Human ’ conference held at Dublin City University in October 2011; the basic argument of Chapter 8 got its first outing at a seminar at the University of Bristol in December 2010. All the material here has benefited greatly from discussion with colleagues in Manchester, especially in the course of CSEP and iSEI seminars run within the School of Law, and elsewhere. For fear of missing anyone out, I won’t attempt to name names – but I ’ m very grateful to all of them for their comments and arguments and companionable sessions in the pub afterwards. I would also like to acknowledge the stimulus and support of the iSEI Wellcome Programme “The Human Body: Its Scope, Limits and Future.” 1 1 The Good of Bioscience T his is a book about ethics, and about the biosciences, and about some of the things that the former can tell us about the latter, and – in one chapter, at any rate – whether the latter can help us satisfy the demands of the former. Ethics is conventionally thought to be about discerning right from wrong, and perhaps advocating the former. Bioethics is a branch of ethics that is about discerning right from wrong and perhaps advocating the former in relation to the biosciences and medicine. This is not surprising: most people’s contact with ethics or ethicists comes, if it comes at all, when those ethicists appear in the media to talk about the rightness or wrongness of this or that action, or about how such-and-such an innovation should be regulated. Nor is the view entirely inaccurate: thinking (and sometimes talking) about the rightness or wrongness or the need to regulate things is an important part of the ethicist’s job; and if ethicists are reluctant to take on the role of advocate, this is only because ethics as a field of study in the Western tradition is still only a couple of thousand years old, and debates about what is right plainly can’t have been settled definitively in that short a time. But it is not the whole story. While its true that ethicists do – at least sometimes – opine on rightness and wrongness, that isn’t all there is to the discipline. (Elizabeth Anscombe famously argued in 1958, of course, that the view that ethics is concerned with the study and application of rules about rightness and wrongness is something of an add-on to what ethics was at the start of the Western tradition. 1 ) Aristotle, for example, thinks that the scope of ethics is far wider than rule-setting. In the first couple of sections of the Nicomachean Ethics , he puts forward the hypothesis that all human activity is directed towards some good – the ‘ good for man ’ (I ’ ll take the liberty of referring to it as the ‘ human good ’ from now on); and it follows from that that knowledge of that good is of great importance. The study of the human good, he continues, belongs to ‘ the science of politics’ ; political science ‘ lays down what we should do and from what we should refrain ’ in its pursuit. The investigation he undertakes within the Ethics is meant as a contribution to precisely that kind of political science. 2 The Ethics – and, implicitly, ethics itself – is concerned with securing the human good and (to take another of Aristotle’s turns of phrase) eudaimonia : the flourishing ‘ good life’ . 3 2 BIOSCIENCE AND THE GOOD LIFE We can take from this the idea that ethics may involve arguments about right and wrong; but that is as a part of a much less moralizing project, which is to get to grips with the contours of the human good, and make recommendations about what is and is not advisable in the pursuit of that good. It’s this idea of ethics that’s going to inform my claims over the coming chapters. And because the biosciences – medicine, surgery, pharmacy, and so on – seem to take as their aim the human good as well, it would follow that ethics might have something to say about them. More, this something could well be richer than a set of claims about this or that procedure being permissible or impermissible: it would ask whether a given application of the biosciences really is conducive to the human good, and whether it’s worth pursuing if the human good is its stated aim. On the face of it, there is little question that the biosciences have contributed significantly to the human good. All of us could quite straightforwardly count ourselves as lucky to be alive today: at no previous point in human history have we had such power to combat illness and premature mortality. Illnesses that might have killed thousands every year not so many generations ago may well be almost trivially easy to treat now – assuming, that is, that they are still threats at all: smallpox is no longer a threat, and it’s only politics that prevents the eradication of polio. Certainly, there are illnesses that we still struggle to treat: but there are reasonable grounds for optimism that at least some of them will become curable within the tolerably near future, and those that remain stubbornly incurable will at least be manageable. We understand a great deal about the causes and basis of a lot of illness; we can, at the very least, begin to map out what a definitive cure would have to do. For example, the Human Fertilisation and Embryology Authority recently (late autumn 2012) carried out consultation on ‘mitochondrial transfer’ – techniques for avoiding mitochondrial disease by, in effect, providing mitochondrial DNA transplants. Or – and this is my favourite current example of a future medical application for embryonic bioscience – we could use synthetic biology to realize the possibility of designing viruses to our own genetic blueprint that would destroy tumour cells without harming non-cancerous cells. (The AAV2 virus has been discovered to attack a large number of cancer cell lines without attacking healthy tissue; 4 it (or similar organisms 5 ) could conceivably be engineered to a higher degree of specificity and efficiency.) Nor is the potential capacity of the biosciences limited to reducing morbidity. As we’ ll see in later chapters, we could imagine them being put to use in other ways – for example as strategies to increase athletic or cognitive ability. Were it to be found that there is a correlation between, say, a version of a given gene and increased mathematical ability, we might imagine parents-to-be selecting embryos that carry that gene – or, slightly more radically, having it artificially inserted into embryos. Such procedures are science-fiction at the moment – but they needn’t be forever. If we think that the human good would be served by making use of such technologies, we might well think that they would be worth THE GOOD OF BIOSCIENCE 3 our while investigating. Such investigations might, some argue, even turn out to be obligatory. There are some bioethicists who do not share such optimistic visions of what can be provided to us by the biosciences – and who are, in fact, positively suspicious of the promises made by them or on their behalf. I’ll give voice to some of these arguments in the next chapter – though I will, in the end, dismiss them. I shall take it as more or less axiomatic that just about all possible future uses of the biosciences to serve the human good are morally permissible. The main possible exception to this rule of thumb is presented by ‘moral enhancement’, which I discuss in Chapter 7 and which I believe risks sacrificing an important aspect of human dignity 6 on the altar of too fragile a conception of goodness. Still – if ethics is not just a matter of working out whether things are permissible or impermissible, assuming that the majority is permissible will not exhaust the scope of ethical debate. What remains to be seen is which applications of the biosciences stand a realistic chance of making a significant difference for the good, and whether that difference really does require bioscientific intervention. It’s by asking this kind of question that I hope to be able to contribute to the bioethical debate that has come to the fore in the past few years concerning the promise that human lives can be made significantly better – and perhaps significantly different – by the application of recent advances in the biosciences and medicine. My question will concern the ability of a range of possible things that might get done in the realm of the biosciences to contribute to ‘ the human good’ , or ‘ the good life’ . I want to ask not so much whether this or that ought to be done, as whether there is much of a reason to do it. And, though I reject the worries of the so-called‘ bioconservatives’ concerning the application of the biosciences, I shall also be distancing myself from some of the more optimistic voices. I shall be defending the claim that there is no particularly strong reason for any agent concerned with living the good life to pursue a significant number of the enhancements that are offered by the biotechnology of recent years or the expected near future; one doesn’t really have to enhance to live the good life. In fact, more strongly, I suspect that there is at least one area in which we might well stand a better chance of living the good life by forgetting about what science might be able to do for us altogether: in this area, the benefits are not only illusory, but counterproductive. But that will have to wait: for the time being, it behoves me to say something more about how I understand the Aristotelian ‘ human good’ . Understanding the good life Given my aim of assessing the contribution that the biosciences might make to flourishing or the good life in future, it is tempting to try to give a full account of what the flourishing or good life would look like – not least because of the 4 BIOSCIENCE AND THE GOOD LIFE suspicion that it would be difficult or impossible to make any particularly claims or assessments of the place of the biosciences in securing it without one. This is a temptation that I want to resist – not least because such a task would probably turn out to be huge, and to have a great many pitfalls. And I don’t think it ’s necessary to provide a full account – one can make some general claims about at least some of the characteristics that a good life would display without having a complete account to hand; such a general account is plenty to be able at least to begin to say something useful about the biosciences. What matters is that words like ‘ flourishing’ have a meaningful place in the language-game that we play. To this extent, ‘ flourishing’ need be no more substantial than a Wittgenstinian ‘ beetle in a box’ . 7 Wittgenstein’s metaphor for the relationship of words to ideas requires that we imagine a number of people, each of whom has a box into which none of the others can see; each agrees that the word ‘ beetle’ refers to whatever is in the box. In this thought- experiment, it does not matter whether each box-holder actually does have the same thing as the others; it doesn’t even matter whether there’s anything in the box at all. However, we could imagine people comparing notes about their beetle’s characteristics, and reaching a consensus about the appropriate use of the word. That is – they could work backwards from the role that the word plays in the language, and attempt to home in on giving it a precise extension. It might be possible to say that certain things aren ’t a beetle quite easily. Indeed, it’s only by excluding things that the word could be said to mean much at all, on the grounds that a word that means everything by that token means nothing. Some exclusions can be empirically informed (if we agree that beetles are characteristically found in matchboxes, they cannot be 75 feet tall); some conceptually informed (they cannot be vertebrate insects, given agreed usage of the words ‘ vertebrate’ and ‘ insect ’ ). Beyond this sort of thing, though, there can be debates about what makes a beetle that might never be definitively settled: the meaning of the word might be indefinitely contestable and contested – but this does not mean that the word is meaningless. It does carry some weight in language, and it doesn’t seem to be completely incoherent. As with ‘ beetle’ , so with ‘ flourishing ’ . The word’s carrying weight in the language means we can start to look for something essential for it to mean if we want – but we don’t have to; and we don’t have to have access to its essence in order to be able to make claims about what it isn’t, and to venture hypotheses about what is unlikely to contribute much to it. Questions of what constitutes flourishing (and what contributes to it) will then be matters for deliberation – which implies public debate and judgement according to standards of reasonability – and evaluation, based on how much from a list of desirable attributes and capabilities a life displays. That is to say, people can still articulate claims and hypotheses about the characteristics that one would expect within the good life; and these would still be scrutable by others. (This is an idea articulated and influenced by Martha Nussbaum’s work. 8 ) THE GOOD OF BIOSCIENCE 5 The public aspect of deliberation is, actually, of crucial importance. This is for a couple of reasons. The first is that, since there is no reason to believe that individuals are infallible in their assessments either of what flourishing is or of how best to achieve it, anyone who cares about maximizing his own flourishing will have a reason to accept the possibility that his understanding of what the word indicates is flawed in some way. And this means that anyone who takes his pursuit of flourishing seriously would have a reason to subject his particular understanding of the concept to refinement from other minds. He may simply have overshot the mark on some occasions, believing that something is necessary for a good life that public deliberation might lead him to discover is not. (One of the things that I’ ll be arguing over the first half of this book is that a number of putative enhancements are all very well, but that they represent, at best, an inessential way of living the good life.) The second is that there may be lapses and lacunae in his reasoning; he may have missed some aspect of the good life or how to live it. Again, the process of public deliberation may make these gaps clear to him and help him fill them. That someone may overshoot the mark in respect of his expectations concerning the good life is important, because – for reasons that I’ ll elaborate in the coming sections – one of the things that may hinder flourishing is the inability to realize the ideas about himself that an agent has. But even without pre-empting that discussion, it is fair to say that there could be some expectations that a person has about a good life that are simply unreasonable, and that public scrutiny and deliberation would allow them to be ‘ tamed ’ . Some things, for example, might be straightforwardly impossible for anyone to realize; to include these things as criteria for a good or flourishing life is therefore foolhardy. At this point, it might be worth forcing a distinction between things that are ‘ radically’ impossible, and things that are not possible in a more workaday sense. I’ ll take ‘ radical impossibility’ to refer to things that are beyond the scope of human possibility, and the latter to refer to things that are merely not possible given the resources currently available. For example, one of the things that might make a person’s life better and bring her closer to flourishing is that she should be fairly fortune-favoured. Immunity from bad luck might be something that would contribute significantly towards a good life; and yet to suppose that there could be some kind of prophylaxis against bad luck stretches credulity. Immunity from bad luck is, therefore, radically impossible. Immunity from cancer, on the other hand, is merely not currently possible. At least at first glance, it would be foolish for someone to think that immunity from misfortune is a criterion for flourishing, even though it might well be desirable; this is the sort of thing that public deliberation would be able to regulate. I’ ll come back to this point in a little while. Another feature of the claims and hypotheses about the good life that might be advanced is that they are likely to draw on a web of other claims about 6 BIOSCIENCE AND THE GOOD LIFE human nature – each of which is, in turn, open to scrutiny itself. Aristotle provides a nice example of how this kind of argument might work at the start of the Politics : granted the hypothesis humans are, by nature, social animals, it follows (he reasons) that they will flourish within a social context, but not without one. Famously, any creature that has by its nature no social ties is either a beast or a god; 9 implicitly, anyone concerned to promote or pursue flourishing will have a reason to seek it within a social context. The same kind of reasoning could, mutatis mutandis , be produced in respect of any attribute whatsoever. Being animals, humans are by nature oxygen-breathing, which means that a reasonably good life will involve some, but not too much, oxygen; if humans were by nature aquatic, then the good for humans would involve water, and so on. Other claims about human nature might be more contestable, though the general point stands. The point at the moment is simply this: to establish that it is possible to talk meaningfully about flourishing without having to have a complete positive account of flourishing present at hand. We can hope to be able to home in on it by means of deliberation and argument about what is reasonable – at the very least, by a process of elimination. As a placeholder, I offer here a hypothesis about what would constitute a good, or flourishing, life: the good life (for humans) is the life that could reasonably be held to be desirable (given a set of background claims about human characteristics). In slightly more detail, a good enough life is the kind of life that people could reasonably be expected to treat as acceptable; lives would be better the more they improve on being merely good enough, to the point at which the best life would be reasonably expected to be unimprovable. 10 With this – admittedly minimal – hypothesis as a guide, we can begin to try to work out what is and is not likely to be a feature of the good life: it is better than good enough , but need not be unimprovable. We can dismiss immunity to misfortune as being a necessary component of flourishing, on the grounds that since it is radically impossible, it is absent from any life – but since almost all lives are at least good enough, it must not, modus tollens , be required. Happiness and flourishing Forced to give an initial hypothesis about a major characteristic of a flourishing life, one obvious response would be that it would be happy. This is quite possibly true: but we cannot deduce from that that increasing happiness is a straightforward route to a better life – and we can certainly dispute the idea that the best life is the happiest, in the sense of being the most pleasurable, life. I think that it’s fairly easy to establish this. Presumably, if flourishing were to be interpreted in terms of happiness, more happiness would mean more THE GOOD OF BIOSCIENCE 7 flourishing. A person in a state of constant euphoria would be flourishing the most. So: imagine that someone is offered the opportunity to be wired up to some contraption that will stimulate the parts of his brain that produce happiness, and will either disable those parts of the brain that produce unpleasant feelings or modify them so that they are reliably and comprehensively overridden by happiness. In other words, imagine that he has the opportunity to spend as long as he wants with a guarantee of happiness and only happiness. Would this amount to an opportunity to flourish? I think that it would not. One of the reasons for this is that the life on which he is about to embark is not recognizably human, and so does not seem obviously to fit the brief of providing human goodness: at least at first glance, it is odd to countenance the idea that catatonia and flourishing really inhabit the same sort of moral territory. I ’ m not sure that this is the best possible reason, admittedly; it seems to assume a great deal about human nature, and to be a little question-begging concerning the nature of the good life. A more powerful reason is much more workaday, though, and it’s that someone who was made no less happy despite any and all the things that might happen to him would have no obvious reason to eat, move to the bathroom before excreting, or attend to his bedsores. His life might be blissful, but it would likely as not be short and squalid. Not, admittedly, that he would care: but if people deliberating about the content of a hypothetically good life rejected this model as being the kind of life they would choose for themselves, it would be hard to maintain that they, rather than he, had made a mistake. So even if there is a reason for people to want this kind of pleasurable existence – and I ’ ll accept that there is – it appears to me that pleasure will not suffice to establish flourishing. A flourishing life is one in which we might seek to eliminate hardships that we experience – but it is likely all the same to be one in which we do experience them. Those who would be lotus-eaters have made a mistake about what constitutes the good life. At the same time, I don’t think that it would be unreasonable for a person to think that a flourishing life would be one that doesn’t attract the pity or contempt of others: but lying in one’s own filth with a fixed grin on one’s face could reasonably be hypothesized to do that. It’s quite conceivably something that a reasonable person would want to avoid for himself; and it’s therefore not a part of the good life. So: a good life is not reducible to being a pleasurable life. While happiness may be an important indicator of flourishing, it ought not to be taken as the sole or sufficient indicator of flourishing. Is it a necessary criterion, though? It makes perfect sense to talk about the rosebush in the garden as flourishing, and it takes no pleasure from it. I think it likely that pleasure would be a part of a good life, inasmuch as that a good life seems to be by definition one that is better and more desirable than neutral. A neutral life would be one the end or continuation of which was a matter of complete indifference to the one 8 BIOSCIENCE AND THE GOOD LIFE living it. Since I’m reluctant to commit to the idea that pleasure is the only characteristic of a good life, it might turn out that the goodness that pleasure provides is matched by the goodness that something else provides; and so someone could think his life worth living despite the absence of pleasure. (Perhaps a grim sense of duty for its own sake would fit the bill; or it might be that someone could say to herself that she is neither happy nor miserable, but wise, and that wisdom is worth having.) For sure, a life like this may be better for having pleasure in it, but there is no real reason to suppose that its absence is a deal-breaker. The importance of projects ‘ But what do we do now, now that we are happy?’ 11 asks Estragon in the second act of Waiting for Godot . It’s not a bad question, really. Granted that a miserable life would not be a good life, it doesn’t follow that happiness is enough; so what else has to be present to secure the good life? I contend that a necessary part of the good life is the presence of projects of one sort or another. Humans are temporal creatures. Unlike at least some other animals, we have a sense of ourselves enduring, and the ability to survey our lives as lasting throughout time. This means that we have a stake in the future, and a corresponding interest in our own futures. Importantly, our ability to see our lives as stretching out into the future – more: our inability not to see that life stretching out into the future – means that we are susceptible to boredom. For as long as he could conceptualize himself as persisting for an indefinitely long time into the future, someone without any projects would not stand to derive any satisfaction from that life; rather, it would yawn ahead of him as something, at best, to be endured. And a life that does not promise any grounds for satisfaction is quite plausibly less good than one that does. (Being alive is not its own reward.) For this reason, it would seem that a person who lacks projects would not be one to whom we could ascribe flourishing; rather, his life would seem to be strangely listless. (If this argument holds water, it implies that it is better to have things that one would like to do but which are yet undone, than it is to have realized all of your projects and have nothing more that remains to be done. I accept this implication, and it’ ll prove to be an important consideration when it comes to analysing the good of significant life extension when we look at that in Chapter 4.) Relatedly, someone who has no projects at all, however minimal, would seem to have no particular stake in the future. Lacking any such stake would mean that he would have no obvious reason to be anything but indifferent about surviving to see that future. 12 Granted, he would be relieved of certain burdens – notably, the worry that his projects might founder. Yet this is only a THE GOOD OF BIOSCIENCE 9 great burden on the assumption that the good derived from a project depends on its completion. Such an assumption is dubious: though a hike ‘ contains’ the idea of its completion, the hillwalker is interested in the walk rather than its termination, for example; the concertgoer wants to hear the music being played. It is not therefore obvious that seeking protection against projects being unrealized by having as few as possible is really the best move; a life lived according to this rubric would likely be more indifferent than particularly good Recognizing a role for projects helps us understand the place of happiness in the good life, too. The thought here takes its lead from a suggestion made by Bernard Williams in his ‘ integrity objection’ to utilitarianism. Williams is dissatisfied with utilitarianism ’s claim to be concerned with the promotion of happiness as the end to which actions are and should be directed, claiming that to emphasize happiness as an end misses something important. ‘ One has to believe in, or at least want, or quite minimally, be content with, other things, for there to be anywhere that happiness can come from’ , 13 he reasons. We may derive happiness from the pursuit and occasional realization of projects – but that is not the reason why we embark upon a project or live that kind of life to begin with. Rather, the happiness generated comes from living a certain kind of life. Though the pursuit of projects is a source of happiness, neither hillwalkers nor concertgoers do what they do for the sake of being made happy by it; if they did, they ought to be indifferent between that activity and a neurological implant that will assuredly beam just as much happiness directly into the brain. I ’ ve already argued that that wouldn’t be a reasonable thing to want; but we can now add to the reasons I produced earlier another: that such an implant would strip the euphoric life of its recognizable ‘ mineness’ . Happiness is undeniably a good thing – but it is found in a certain life. The point of being a hillwalker is the walking of hills; the pleasure derived is not (and is not supposed to be) substitutable for other pleasures. So we can begin to understand Estragon’s question. Becoming happy and then wondering what to do show s that happiness up as the sham it is. But while there’s nothing to be done (he and Vladimir tell us as much twice each during Act 1), that’s all there is; and his life won’t be a good one. On the other hand, if there is something to be done, and that something is something with which Estragon can identify to the extent of being able to say that it’s what his life, or this part of his life, is about , then he stands a chance of being happy ‘ by accident’ – and his life stands a chance of being good. Function and the good life What else may we come to expect to see in a good life? It would be a surprise not to see some recognition of physiological function there, inasmuch as that 10 BIOSCIENCE AND THE GOOD LIFE it ’s tempting to think that a good life will be one in which the body behaves as bodies ought – but even here, things aren’t necessarily as straightforward as we might think at first. The problem is that talking about bodies functioning more or less well presupposes a great deal about the standard that we’re supposed to be using to measure that function. Certain things might be fairly easy to agree: a wound that won’t heal is pretty straightforwardly a sign of dysfunction, for example. But other things are harder to agree. Too naïve an account of function and dysfunction in relation to flourishing might well struggle to make sense of the fact that a lot of people seem to flourish despite some ostensible physical dysfunction, and would not obviously benefit from bioscientific intervention. For example: imagine that a person – call her Joanna – is deaf. We can stipulate that this is because of some congenital characteristic, and that modern bioscientific insights have given us the ability to give her the ability to hear. But it is not a given that Joanna’s deafness prevents her from flourishing: there are plenty of deaf people who believe that their lives are different from, but no worse than, the lives of their hearing counterparts, for example. Joanna might believe that being able to hear would be a boon; but she might not. Either way, it is not obvious that she would have to think it worth the effort, and she might even think it undesirable. What will make a difference to whether or not any such intervention is warranted will have a lot to do with whether she misses the capacity to hear; this will have a lot to do with the kind of life she wishes to lead; and much of that picture will, in turn, be informed by the kind of projects that she has for herself. If it happens that Joanna does not miss hearing, we can say that her deafness is in one sense a dysfunction, without having to admit that it makes any particular difference to her flourishing. Therefore flourishing can’t depend closely on function in this tight, and slightly scientistic, sense. Or imagine that Brian is infertile. On certain accounts, this is straight forwardly a dysfunction, and a characteristic that it would be better not to have. However, it is not clear why a bare description of this characteristic would allow us to say anything about how his life could be improved: there is no obvious logical link between a barely descriptive statement about a person’s physical characteristics or attributes, and a statement to the effect that these characteristics or attributes matter. It is by means of appealing to certain projects – notably, the project of raising a family that is genetically related to him 14 – that we can draw a link between a bare description of function, and Brian’s flourishing. If infertility impacts on flourishing, that is, it does so only in the context of a particular kind of parental project that is not realized. Without such a project to make sense of that desire, it might be wholly unclear why providing it would make any improvement to his flourishing. Neither of these examples deals with illness; but it might be possible to extend the account even there, to help us work out what is meant by words THE GOOD OF BIOSCIENCE 11 such as ‘ health ’ and ‘ illness’ . Havi Carel is insightful here, suggesting that the healthy body is ‘ transparent’ , and that while digestion, fluid balance and muscular performance are going well, we do not experience them consciously. They silently and invisibly enable us to compose symphonies, have coffee with friends and argue about politics. It is only when something goes wrong with the body that we begin to notice it. Our attention is drawn to the malfunctioning body part and suddenly it becomes the focus of our attention, rather than the invisible background for our activities. 15 The difference between illness or certain kinds of injury and a dysfunction such as infertility is that the former interfere with our lives on a much more pervasive level, and so their impact is felt in the context of much more mundane projects and activities that we are used to pursuing and performing ‘ at a certain speed, in a certain way’ – things as mundane as chopping vegetables, or moving from one room to another. Carel suggests that [i]llness distances us from the biological body, which becomes alienated and erratic, the source of pain and disability. The lived experience of this body becomes painful, unstable, treacherous. The distance from the biological body is not normally available to us while we are healthy. Illness (as well as other kinds of physical alteration) removes the body’s transparency and problematizes it. 16 It’s in doing things that illness often makes its presence felt. As such, there’s a connection between illness and projects – or, more widely, doing things – just as there is between dysfunction and projects. The naï ve functionalist account would also potentially struggle with the fact that a lot of other people may apparently be helped to flourish by some intervention notwithstanding that that particular intervention does not address any particular dysfunction. If this help is not illusory, it undermines the possibility of drawing too neat an association between function and flourishing. Instead, we need to be able to give any such association a context; appeals to projects can do this, and also give us a reason to think that there are means in which the biosciences can help the non-dysfunctional to attain higher levels of flourishing. For example, in Chapter 5, I’ ll consider situations in which a people might choose to take advantage of biomedical interventions to make their lives better without there being anything much wrong with them to begin with. Of course, projects might not be the whole story. People do have a concept of themselves, and they might well be able to point to a sense of personal integrity as being important in their assessments of their flourishing. For example, women who have had a mastectomy are frequently offered reconstructive surgery, and one of the rationales offered for this is that it is of psychological benefit – that it may not assist with the cure for cancer, but that it does help with healing. 17 A procedure such as gender reassignment surgery could also draw on this kind of 12 BIOSCIENCE AND THE GOOD LIFE argument: if a person is convinced that they do not ‘ fit’ their sexual phenotype, this can cause a severe diminution of flourishing – a diminution that we might legitimately hope to halt or reverse; and no further project would be necessary to make sense of how such an intervention would contribute to flourishing. So we might be able to enhance a person’s level of flourishing by modifying their body in some way in accordance not with any particular project, but rather in accordance with their vision of the kind of person that they are on a more existential level. Still: the relationship between physical considerations such as (but not limited to) health and flourishing is potentially quite complicated. A person might be flourishing notwithstanding some characteristic that could, from at least some perspectives, be seen as dysfunctional; and their flourishing could be improved despite the absence of any dysfunction. This appears to count against placing too much stress on the distinction between therapy and enhancement. If the justification of the use of the biosciences is to improve flourishing – to make lives better – then it ought not to concern us too much whether the intervention in question is aimed at rectifying some dysfunction or illness, or improving an already functional state. There are projects that a person might have that are hindered by the bare realities of their body even when that body is not dysfunctional in any relevant sense; and if having one’s projects hindered is capable of denting a person’s flourishing, and if the realization of those projects can be assisted by making use of the products of the biosciences, then that is at least prima facie all we need for there to be a warrant for using them. It makes no difference whether we are restoring or repairing in a person who lacks the capacities that most people do have, or whether we are giving them capacities that most people don’t. I will, however, return to the therapy/enhancement distinction in a little while. The reasonable expectation standard I ’ ve already indicated that someone without projects, though probably not living anything like a good life, would at least be able to ensure that she is never disappointed by their not having come to fruition. Similarly, a person with no particular conception of themselves as having this or that kind of life cannot be let down by its not having been realized. And it does seem reasonable to suppose that a life that is marked by disappointment will be less good than one that is not so marked. As such, disappointment is corrosive of flourishing. It is, in fact, ‘ positively ’ undesirable: though the value of a project and its contribution to the good life doesn’t depend on its having been realized, still, to be positively disappointed might well mean that one flourishes less . So this means that there is at least a possibility that a life without projects, though barely worth the THE GOOD OF BIOSCIENCE 13 candle in its own terms, might be just-about better than a life characterized by systematic disappointment. Still, this is hardly a ringing endorsement of such a pessimistic life. More importantly, a person who withdrew from life in order to guarantee not being disappointed could, I think, be said to care less about the good life than about securing the least-bad life; as such, he’ d be satisfied with a life that’s just about good enough – not as good as some, though not as bad as others. I think we can assume that a person could justifiably aim higher than that. I have already claimed that the nature of the good life is a matter for public debate; and, this being the case, it is likely also that the means by which we might try to attain it is also quite properly material for public debate; and just because a given project or view of the good life is pursued sincerely and in earnest, it doesn’t follow that it can’t be misguided. To this extent, claims about the good life can